[Acceptance of patient-related evaluation of wrist function following distal radius fracture (DRF)].

INTRODUCTION: Outcome evaluation after distal radius fractures is mainly based on wrist function and radiological parameters, while measuring patient satisfaction seems to be more difficult. The purpose of this study was to assess different subjective features with regard to patient satisfaction for wrist healing, activity and participation.
MATERIALS AND METHODS: A questionnaire combining items from the established PRWE (Patient related wrist evaluation), wrist-specific items from the DASH (Disability of Arm, Shoulder and Hand) as well as the ICF questionnaire (international classification of function, health and disease) was created, and then distributed to patients without wrist injuries (group 1) and patients following a distal radius fracture (group 2). Analysis of answered questions was performed with regard to response rate, valid content, mean differences between the two groups, correlation with radiology features in the patient group and age.
RESULTS: Of 510 individuals with non-relevant wrist injuries, 96.7 % of the questions were answered, while of 133 distal radius fracture patients, 92.2 % of the questions were answered, rendering a total response rate of 95.5 %. Frequency of not responding to questions varied between 1.4 % to 14.4 %, and remained < 5 % for 17 questions. Internal consistency of the questionnaire with regard to wrist function was high in both groups (Cronbach alpha index for patients with non-relevant wrist injuries 0.9836, for distal radius fracture patients 0.9881). All questions were deemed specific for wrist function (discriminatory power > 0.7), and highly significant (p < 0.01) for ascertainment of subjective comfort after distal radius fracture in comparison with non-relevant wrist injuries. Fourteen of 25 questions (56 %) were correlated significantly (p < 0.05) with radiological features of malunion. For ages 30 to 49, and > 70 years, wrist function was deemed worse in the distal radius fracture patients vs. the non-injured wrist group. For ages 50 to 69, a significant difference was found only for 5 of 25 (20 %) questions.
CONCLUSION: All questions were of a high validity and significance to determine subjective outcome after distal radius fractures. Patient acceptance was significantly different for questions, and subjective wrist comfort depended on age. For ages 50 to 69, additional questions in terms of employment situation and recreational function could be incorporated. Only about half of the questions correlated with radiological parameters of distal radius malunion. Eight questions showed both high acceptance and high correlation with radiology. Standardised measurements of range of motion and power, as well as radiology features and subjective questions of high acceptance and radiology relevance are essential for a wrist-specific questionnaire.